Elizabeth Bailey, MD

Abstract

Introduction: Art education interventions improve observation skills among dermatology residents, but there is limited data regarding their benefits to wellness and clinical communication.Methods: Residents in the Stanford dermatology residency program participated in an arts-based education session, repeated in the fall of 2018 and 2019, that included a rotation of observational exercises adapted from the Artful Thinking program through Harvard Project Zero. The 2018 session featured exercises on identification and understanding of visual observation, while the 2019 session featured exercises on perspectives and objectivity of visual observation. Participants completed preintervention, postintervention, and 3-month follow-up surveys in fall 2018 and a postintervention survey in fall 2019.Results: Twenty-one residents participated in the 2018 education session and produced an adequate response rate (62%-90%) across surveys. At 3 months, five of 13 residents (39%) reported new use of art for mindfulness and stress reduction, 12 of 13 (92%) could recall an example of use of observation to improve patient communication, and four of 13 (31%) confirmed and described adjustments to their handoff technique. In 2019, 13 out of 18 participants (72%) completed the postintervention survey. Responses reinforced themes from the prior iteration but focused on perspective, objectivity, context, and uncertainty in observations. Respondents also identified additional arenas of communication to benefit from these observational techniques.Discussion: Dermatology residents increased use of art for personal wellness and adjusted clinical communication strategies after a single arts-based education session. Annual repetition with novel exercises maintained engagement and yielded additional participant insights.

View details for DOI 10.15766/mep_2374-8265.11133

View details for PubMedID 33816794

View details for DOI 10.1016/j.jaad.2020.03.061

View details for PubMedID 32234307

View details for DOI 10.1001/jamadermatol.2020.0113

View details for PubMedID 32186684

Abstract

New modalities of evaluating histopathology, such as whole-slide imaging, have been validated in the field of dermatopathology but are often unfeasible and unavailable in developing countries. Widely available across the globe, mobile phone camera technology represents a potential simple and inexpensive method of imaging histologic slides through the use of a mobile phone camera microscope adaptor. This study aims to validate the use of a commercially available adaptor in the diagnosis of inflammatory and infectious conditions in dermatopathology. Representative images were taken of slides for fifty-four cases using the adaptor and shared through a cloud-based platform with five dermatopathologists who rendered diagnoses and judged the quality of the images. After a washout period of 8 weeks, the same cases were assessed by the same dermatopathologists using the original glass slides. The intraobserver concordance rate was 93.3%, and the quality of the mobile phone images was rated as "excellent" or "diagnostic" in 94.4% of the cases. This study validates the use of this low-tech and low-cost adaptor as a reliable tool in teledermatopathology. Limitations of the study include those inherent to use of the adaptor and the limited panel of diagnoses. The primary value of this device may be in developing countries, but its practicality and ease of use lend itself to use in academic and consultative settings in the developed world as well.

View details for DOI 10.1097/DAD.0000000000001529

View details for PubMedID 31633596

View details for DOI 10.1016/j.jaad.2019.07.033

View details for PubMedID 31325549

View details for DOI 10.1111/cup.12816

View details for PubMedID 28000246

Abstract

This study examined the role of random normal skin biopsy in the diagnosis of intravascular lymphoma (IVL) in adult Western patients with clinically diagnosed hemophagocytic lymphohistiocytosis (HLH).In a retrospective chart review study, we analyzed a total of 59 skin biopsies that were performed to diagnose IVL in 21 adult patients with HLH seen at Stanford Hospital between 2004 and 2016.Out of the 59 skin biopsies, 42 were taken from clinically normal-appearing skin and 17 from clinically abnormal-appearing skin. None of the 59 biopsies revealed a diagnosis of primary or metastatic malignancy, regardless of the malignancy history, clinical presentation, and biopsy and histopathologic characteristics. A review of 8 positive IVL cases at Stanford Hospital including 1 case associated with HLH showed 1 positive diagnosis by a targeted skin biopsy and other positive diagnoses by bone marrow (n = 4), lung (n = 2), brain (n = 2), muscle (n = 1), and nerve (n = 1).Random skin biopsies have a limited role in diagnosing IVL in adult patients with HLH, in the setting of a single academic institution in the USA. A review of the literature emphasizes the role of a full body skin exam with a selective skin biopsy in these patients.

View details for PubMedID 28668948

Abstract

Amyopathic dermatomyositis can be a challenging diagnosis because patients lack traditional muscle findings. "Clinically amyopathic" dermatomyositis (CADM) accounts for the presence of subclinical muscle disease in some of these patients. These patients represent a substantial minority of dermatomyositis cases and have similar co-morbidities to "classic" dermatomyositis patients, including interstitial lung disease and malignancy. Clinically amyopathic dermatomyositis patients should not be considered as a distinct clinical entity from "classic" dermatomyositis, as they share antibody sub-types and associated co-morbidities, likely representing clinical spectrum of a common disease. It is essential for the clinician to be familiar with the clinical presentation of clinically amyopathic dermatomyositis, in order to facilitate early, accurate diagnosis and appropriate clinical management.

View details for DOI 10.1007/s11926-014-0465-0

View details for Web of Science ID 000344648600001

View details for PubMedID 25366932

Abstract

Massage therapists encounter skin on a daily basis and have a unique opportunity to recognize potential skin cancers. The purpose of this study was to describe the skin cancer education provided to massage therapists and to assess their comfort regarding identification and communication of suspicious lesions. An observational retrospective survey study was conducted at the 2010 American Massage Therapy Association Meeting. Sixty percent reported receiving skin cancer education during and 25% reported receiving skin cancer education after training. Massage therapists who examine their own skin are more likely to be comfortable with recognizing a suspicious lesion and are more likely to examine their client's skin. Greater number of clients treated per year and greater frequency of client skin examinations were predictors of increased comfort level with recognizing a suspicious lesion. Massage therapists are more comfortable discussing than identifying a potential skin cancer. Massage therapists may be able to serve an important role in the early detection of skin cancer.

View details for DOI 10.1007/s13187-012-0403-7

View details for Web of Science ID 000316820900024

View details for PubMedID 22915212

Abstract

To summarize the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis.We performed a systematic search for all entries in PubMed, CINAHL, Cochrane Review, and EMBASE related to combination treatments for psoriasis through July 2010.We included randomized controlled trials that reported proportion of disease clearance or mean change in clinical severity score (or provided these data through communication with study authors) for efficacy of a combination treatment for psoriasis compared with 1 or more corresponding monotherapies.Study data were extracted by 3 independent investigators, with disagreement resolved by consensus. The proportion of patients who achieved clearance, definition of clearance, means and standard deviations for baseline disease symptom score and final disease symptom score, and major design characteristics were extracted for each study.Combination treatments consisting of vitamin D derivative and corticosteroid, vitamin D derivative and UV-B, vitamin A derivative and psoralen-UV-A, vitamin A derivative and corticosteroid, vitamin A derivative and UV-B, corticosteroid and hydrocolloid occlusion dressings, UV-B and alefacept, and vitamins A and D derivatives were more effective than 1 or more monotherapies using the likelihood of clearance as the outcome. Blinding status and potency of the corticosteroid treatment used were significant sources of heterogeneity between studies.The results demonstrate the need for additional long-term trials with standardized outcome measures to evaluate the efficacy and adverse effects of combination therapies for psoriasis and highlight the possible effects of trial design characteristics on results.

View details for DOI 10.1001/archdermatol.2011.1916

View details for Web of Science ID 000302870600016

View details for PubMedID 22184718

Abstract

To determine factors related to the observation of suspicious lesions on the scalp, neck, and face of customers by hair professionals (cosmetologists and barbers).Survey of hair professionals in January 2010.Single hair professional educational conference.Hair professionals from a chain of 17 salons in the greater Houston, Texas, area.Frequency with which hair professionals looked for lesions on their customers' scalp, neck, and face during the previous month.Of 304 surveys distributed to hair professionals, 203 were completed (66.8% response rate). Few hair professionals had received formal skin cancer education (28.1%). Forty-nine percent of hair professionals were "very" or "extremely" interested in participating in a skin cancer education program. Of responding participants, 37.1% looked at more than 50% of their customers' scalps, 28.8% looked at more than 50% of their customers' necks, and 15.3% looked at more than 50% of their customers' faces for suspicious lesions during the preceding month. Frequency of observation of customers' lesions was associated with hair professionals' self-reported health communication practices (P < .001) and personal skin protection practices (P = .05) but was not associated with hair professionals' skin cancer knowledge (P = .48).This study suggests that hair professionals are looking for suspicious lesions on customers' scalp, neck, and face and are acting as lay skin cancer educators. These results provide evidence that hair professionals would be receptive to skin cancer education and that further investigation into the role of hair professionals in skin cancer prevention and detection campaigns is needed.

View details for Web of Science ID 000295944300005

View details for PubMedID 22006132

Abstract

Anti-epiligrin cicatricial pemphigoid is an autoimmune blistering disorder that has recently been associated with the development of solid organ malignancy. We describe a patient with recurrent metastatic prostate carcinoma who was diagnosed with this disorder. We provide a hypothesis as to the relationship between the development of this disease and its possible association with cancer pathogenesis.

View details for DOI 10.1684/ejd.2011.1360

View details for Web of Science ID 000293836300014

View details for PubMedID 21527374

Abstract

Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma. It is a common diagnosis in both inpatient and outpatient dermatology, as well as in the primary care setting. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected area. There are many other dermatologic diseases, which can present with similar findings, highlighting the need to consider a broad differential diagnosis. Some of the most common mimics of cellulitis include venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis. History, local characteristics of the affected area, systemic signs, laboratory tests, and, in some cases, skin biopsy can be helpful in confirming the correct diagnosis. Most patients can be treated as an outpatient with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern.

View details for DOI 10.1111/j.1529-8019.2011.01398.x

View details for Web of Science ID 000288455800008

View details for PubMedID 21410612